Severe acute malnutrition

Albumin Liver M.W. 66,000 15-19 days N 3.5-5.0g/dl Mild 2.8-3.5 g/dl Moderate 2.1-2.7 g/dl Severe <2.1 g/dl Transports many endogenous and exogenous ligands, major determinant of plasma oncotic pressure. Large body pool and long half-life makes it a poor index of acute malnutrition... 

Hepatobiliary disease occurs due to bile duct obstruction from abnormal bile composition and flow. Hepatomegaly, splenomegaly, and cholecystitis may be present. Hepatic steatosis may also be present due to effects of malnutrition. The progression from cholestasis (impaired bile flow) to portal fibrosis and to focal and multilobar cirrhosis, esophageal varices, and portal hypertension takes several years. Many patients are compensated and asymptomatic but maybe susceptible to acute decompensation in the event of extrinsic hepatic insult from viruses, medications, or other factors.7... 

I.6. Various Diseases. Abbassy et al. (Al) observed in 12 cases of malnutrition (including kwashiorkor), toxic dyspepsia, 8 cases of acute nephritis, 8 cases of infective hepatitis, and muscular dystrophy an increased spontaneous excretion of xanthurenic acid, the amount of which was found to depend on the severity of the case. In all these cases, with the exception of acute nephritis and hepatitis, the amount of xanthurenic acid was restored to normal levels after vitamin Be therapy. In 8 children with mental retardation, cerebral palsy, recurrent convulsions, 5 with nephrotic syndrome, and 5 with pellagra the amount of xanthurenic acid spontaneously excreted was found to be within the normal range, indicating that pyridoxine is probably not concerned in these cases. 

Nutrients have a profound effect upon the production and actions of cytokines. Protein-energy malnutrition, dietary (n-3 polyunsaturated fatty acids, and vitamin E suppress the production of specific cytokines. The synthesis of acute-phase proteins and glutathione is dependent on the adequacy of dietary sulfur-containing amino acids. The consequences of the modulatory effects of previous and concurrent nutrient intake on cytokine biology are the depletion of resources and damage to the host, which ranges from mild and temporary to severe, chronic, or lethal. 

Acute renal failure occurs in approximately 5% of all hospitalized patients. The mortality rate of ARF patients who require renal replacement therapy ranges from 40% to as high as 80%. Severe malnutrition has been found in 42% of patients with ARF and is an independent predictor of in-hospital mortality and increased morbidity from sepsis, shock, dysrhythmias, and acute respiratory failure. Since malnutrition is an important contributor to mortality from ARF, nutrition support remains a cornerstone in the treatment of these patients. ... 

Negative acute-phase reactant Chronic inflammation Malnutrition Chronic liver diseases Protein-losing syndromes Iron overload Congenital defect atransferrinemia (severe hypochromic anemia)... 

Other circumstances predispose to significant malnutrition in subjects of any age. Severe trauma, burns, or sepsis are hypermetabolic states requiring massive nutritional support such as hyperalimentation. Nutrition in acutely and chronically ill patients is often inadequate. Even in an informed, affluent society, some people, such as alcoholics, are inadequately nourished because of overconsumption of foods of low nutritional value. For example, wet beriberi has reappeared among Japanese teenagers who subsist on soft drinks, noodles, and polished rice (Kawai et aL, 1980). Macrobiotic vegetarians are prone to the neurologic complications of Bj2 efficiency after years of such a diet. 

Nutritional interventions should contain a balance of protein, energy, vitamins, and minerals. One of the goals is to correct malnutrition without increasing the respiratory quotient (50,51). A severely impaired energy balance in COPD patients during the first days of an acute exacerbation may be associated with a decreased energy and protein intake (52). 

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